ニューヨーク州ブロンクスの子供時代の結核
E Drucker1, P Alcabes, W Bosworth
1Department of Epidemiology and Social Medicine, Monteflore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467-2490.
Lancet (London, England)
|June 11, 1994
まとめ
貧困と混雑した住宅は,都市部における小児結核 (TB) の重要なリスク要因であり続けています. ヒト免疫不全ウイルス (HIV) の流行にもかかわらず,過密化は,子供たちの結核のリスクを劇的に増加させます.
科学分野:
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
- 環境衛生 環境衛生 環境衛生
背景:
- 1978年から1992年にかけてニューヨーク市 (NYC) で結核 (TB) が再発したのは,エイズ (AIDS) 流行に関連していた.
- 都市部の貧困地域での活性結核症例の増加は,コミュニティの暴露率が高いことを示唆しています.
- この研究はブロンクスを中心に,エイズ率,住宅の混雑,および幼児の活性結核との関係を調べました.
研究 の 目的:
- コミュニティレベルでの獲得免疫不全症候群 (AIDS) 発生率とブロンクスの5歳未満の子どもにおける活性結核患者の住居混雑との間の生態学的関連性を調査する.
- 結核の再発における歴史上の危険因子 (貧困,混雑) と新しい危険因子 (HIV) の役割を理解する.
主な方法:
- 1986年から1992年の間にブロンクスで報告された75人の小児結核症例のデータを活用した.
- 住宅混雑は,部屋に1人以上いる世帯の割合として定義される.
- 地域社会におけるHIV感染者負担 (成人女性エイズ死亡率で推定される) と住居の混雑が結核リスクに与える影響をモデル化するために,保健分野別で集約したデータを用いてポアソン回帰を用いた.
主要な成果:
- 1970年から1990年にかけてのブロンクスのTB率と住宅混雑の間の明確な時間的相関が観察されました.
- 住宅の混雑は,貧困,公的支援への依存,より大きな家庭の規模,ヒスパニックの民族,および小さな子供の割合が高いことと関連していました.
- 家庭の混雑に伴い,小児結核の症例率は増加し,1万人に1.47例から8例以上に増加しました.
- HIV負担をコントロールした後でも,重度の過密住宅 (12%以上の家庭) の子どもは,活発な結核の5.6倍以上のリスクがありました.
結論:
- ヒト免疫不全ウイルス (HIV) 感染が結核の再興の重要な要因である一方で,貧困や家庭の混雑などの伝統的なリスク要因は依然として非常に重要です.
- 調査結果は,社会経済的条件と居住密度の結核の伝播と脆弱な集団における結核の発生に及ぼす持続的な影響を強調しています.
- 貧困と住居の状況に対処する介入は,特にHIV感染率が高い都市部での結核の制御に不可欠です.
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